The periodontal disease as used herein is a broad term used to describe those diseases which attack the gingiva and the underlying alveolar bone supporting the teeth. Two common periodontal diseases are gingivitis (inflammation of the gingiva) and periodontitis manifested by progressive resorption of alveolar bone, increasing mobility of the teeth and loss of the teeth at advanced stage). Periodontal disease is characterised by one or more of the following inflammation of the gingiva, formation of periodontal pockets bleeding and/or pus discharge from the periodontal pockets, resorption of alveolar bone, loose teeth and loss of teeth. This disease is generally considered to be caused by/associated with bacteria which are generally present in dental plaque which forms on the surface of the teeth and in periodontal pocket. Inflammation of the soft tissues (gingivae) around teeth is referred to as gingivitis and may be caused by microbial infection. In the case of progressive infection, direct microbial actions as well as the production of tissue-destructive enzymes such as collagenase, with or without stimulation of host tissue-destructive enzyme activity by the infectious agents can lead to destruction of supporting tissues around the teeth, a condition referred to as periodontitis (Klausen et al, 1991). The subgingival microbiota associated with these peridental conditions may be comprised of multiple species and may change during the course and progression of the dental infections. Gram (-ve) anaerobic bacteria in particular, are known to play an essential role.
It is known fact that the mouth is colonized by microorganisms a few hours after birth, mainly by aerobic and facultative anaerobic organisms. The eruption of teeth allows the development of a complex eco-system of microorganisms (&gt;300 species have been identified). In healthy mouth,it depends on maintaining an environment in which these organisms exist without damaging oral structures. The microorganism involved in oral infections (Oxford Handbook of Clinical Dentistry, 2nd Edition) are as follows:
Streptococcus mutans: Aerobic. Synthesizes dextran. Colony density on tooth surface plaque rises to &gt;50% in presence of high dietary sucrose. Able to produce acid from most sugars. The most important organism in the aetiology of dental caries.
Streptococcus sanguis: Accounts for half the streptococci isolated from saliva. Inconsistent producer of dextran.
Streptococcus milleri group: Common isolates from dental abscesses, also implicated in abscess formation at other sites in the body. Three recognized species.
Lactobacillus: Secondary colonizer in caries (mainly dentine).
Porphyromonas gingivalis: Obligate anaerobe. A member of the `black pigmented bacteroides` group which is associated with rapidly progressive periodontitis. Others include Prevotella intermedia and P. denticola.
Fusobacterium: Obligate anaerobes. Originally thought to be principal pathogens in Acute ulceration gingivitis (AUG). Remain a major periodontal pathogen as a collective group. The terminology for specific organisms is confusing and unimportant.
Borrellia vincenti: (refringens) The largest oral spirochaete and once thought to be the major co-pathogen in AUG. This disease is best now thought of as simply an anaerobic, fusospirochaetal complex infection.
Actinobacillus actinomycetemcomitans: Microaerophilic, capnophillic, gram negative rod. Found particularly in juvenile periodontitis and rapidly progressive periodontitis.
Actinomyces israelii: Filamentous organism, major cause of actinomycosis, a persistent rare infection which occurs predominantly in the mouth and jaws and the female reproductive tract. Implicated in root caries.
Candida albicans: Yeast-like fungus famous as an opportunistic oral pathogen, probably carried as a commensal by most people.
Spirochaetes: Obligate anaerobes much implicated in periodontal disease, present in virtually all adult mouths, Borrelia, Treponema, and Leptospira all belong to this family.
It is a known fact that for treating periodontal diseases, antimicrobials are used. Penicillins in general are highly effective antimicrobial compositions against anaerobic bacteria. Some penicillins, such as Amoxicillin, have antimicrobial activity against anaerobic bacterial and some gram (-ve) bacterial species. Nevertheless, both Penicillin G and Amoxicillin have been shown to be ineffective against bacterial species important in peridental infections, such as P.gingivitis.
Also, Tetracyclines are impressively broad spectrum antimicrobial agents with activity against a wide range of bacterial and non bacterial species. However, tetracycline have a number of disadvantages relative to use in dental medicine which are related to their bacteriostatic mechanism of action and broad spectrum activity. For example, the rapid emergence of bacterial strains which are resistant to tetracyclines and the occurence of overgrowth of unsusceptible pathogens, such as Candida during treatment constitute serious limitations to the use of this class of anti-microbials in the treatment or prevention of dental infections leading to teeth loss. The broad spectrum of activity of tetracyclines can result in superinfection of the diseased tissue by bacteria which are unsusceptible to its antimicrobial action, and can also result in opportunistic infection of healthy tissues. Prolonged or frequent treatment courses with broad spectrum antimicrobials enable superinfecting organisms to persist in the sub-gingival microbial community over extended periods of time, contributing to therapeutic failure.
Periodontal diseases can also be treated with a compositon comprising of Metronidazole Benzoate 25% and with a composition comprising of Chlorhexedine gluconate individually.